Provider Demographics
NPI:1780759605
Name:DAVIS, NATALIE A (MD)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:NATALIE
Other - Middle Name:A
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:240 GRACE NELL DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-5797
Mailing Address - Country:US
Mailing Address - Phone:270-331-0218
Mailing Address - Fax:
Practice Address - Street 1:1000 S 12TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-9303
Practice Address - Country:US
Practice Address - Phone:270-759-9200
Practice Address - Fax:270-759-9966
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109023207P00000X
KY43241208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000635268OtherBC
MO209227917Medicaid
KY7100095020Medicaid
KY00931Medicare PIN
KY00931021Medicare PIN
KY000635268OtherBC
KY7100095020Medicaid
MOH38496Medicare UPIN